脑卒中康复与神经康复机制

脑的可塑性和功能重组是神经康复包括脑卒中康复的主要机制。近年来以ＰＥＴ、ｆＭＲＩ、经颅磁刺激(ＴＭＳ)和脑磁图 (ＭＥＧ)等手段获得的脑损害后康复的资料均支持脑卒中后皮质功能重组的概念。我国也己有类似的报道[1] 。1正常与病损后脑的可塑性脑功能重组证明脑具有可塑性。如 :弦乐器操作者左手手指的皮质图较右侧为大[2 ] ;Ｂｒａｉｌｌｅ盲字诵读者的右手皮质图大于左手[3 ] 。有些失去双上肢的残疾人日常生活居然能由双脚活动来代替和操作 ,如果以现代先进设备如ＴＭＳ来检查就可能发现 ,在原已消退或萎缩的上肢皮质代表区已由脚…     

神经影像在卒中后脑可塑性机制中的应用进展

神经影像技术是进行卒中后脑可塑性机制研究的重要手段.弥散张量成像可用于描述白质纤维束结构,评估受损程度,但不能反映不同脑区之间的功能联系;任务态功能磁共振成像(fMRI)可检测特定任务引起对应的脑区激活情况,但试验设计复杂,对受试者要求高;静息态fMRI可进行复杂脑网络分析,反映不同脑区功能联系,但数据分析方法复杂;功...     

丰富康复训练与神经可塑性

神经可塑性是指神经系统对外界环境刺激可做出适应性改变的特性。神经可塑性的理论研究最早开始于脑卒中后的功能恢复。脑卒中后的运动功能恢复主要出现在数周或数月内,通常归因于脑神经的可塑性。已证实将丰富环境和一般康复训练相结合的丰富康复训练可以使大脑达到最佳的功能恢复。如何掌握丰富康复训练的时机和持续时间是当前研究的热点。     

视触觉增强现实技术在上肢康复中的研究进展北大核心CSCD

视触觉增强现实是人机交互领域的研究热点,将它应用于上肢康复领域,能增强上肢康复的效果。本文从系统组成、交互方式以及适用对象等方面对现有的几种视触觉增强现实康复系统进行对比分析。     

胰岛素样生长因子-1在脑外伤康复中的作用研究进展

胰岛素样生长因子-1(IGF-1)在大脑发育和成人神经系统修复中介导许多生理功能,可调节神经元增殖和存活、维持轴突和树突的形态和生长、改善神经炎症、调节血管生成等。本文总结了脑外伤后IGF-1的表达变化、介导的病理生理作用和用于脑外伤治疗的应用进展,旨在为脑外伤康复临床诊疗提供多元化思路。     

丰富环境与神经可塑性

目的：神经系统的发育是遗传因素和环境因素共同作用的结果，丰富环境对脑发育和脑损伤修复具有显的促进作用，而脑发育与脑损伤修复的基础是神经可塑性。因此，关于丰富环境与神经可塑性的研究已成为脑损伤修复研究的热点。资料来源：应用计算机检索Medline 1994-01／2004-08和ELSEVER 1997-07／2004-08期间丰富环境与神经可塑性相关的章，检索词“Enriched environment，Neuronal plasticity”，并限定语言种类为英。资料选择：对资料进行初审，选出与丰富环境与神经可塑性关系密切的进行全查找，浏览全后，筛除重复研究的献，将最新研究纳入提取精读范围。资料提炼：共收集到19篇符合要求的献，其中11篇是关于丰富环境、神经可塑性及二关系的献，5篇涉及丰富环境的作用机制，3篇为问题与展望。资料综合：丰富环境可以提供多感官刺激、运动和社交的机会，丰富环境即可刺激和引起神经可塑性的变化，神经系统的生长发育及其损伤修复都具有可塑性。丰富环境刺激可引起神经形态学结构及行为学功能的改变，其作用机制与神经生长因子、离子型谷氨酸受体及早期即刻基因等变化有关。结论：丰富环境刺激具有引起神经形态学结构和行为学功能变化的效果，使其成为一种有效而低风险的脑损伤康复手段。     

卒中后认知功能康复与神经可塑性

中枢神经系统(central nervous system，CNS)神经细胞之间有广泛神经纤维联系，各个脑功能区之间有丰富的神经纤维联络．左右大脑半球间可以通过胼胝体进行信息交流，皮质和皮质下神经结构，以及脑干、小脑间有复杂的环路，这些构成了中枢神经系统(脑)可塑性的物质形态学基础。CNS可塑性与神经细胞再生、突触可塑、神经网络重塑、脑功能重组和功能区转移等密切相关。     

星形胶质细胞在突触可塑性中的研究进展

星形胶质细胞是脑内数量占比最高的细胞,其可通过终足包绕神经元的胞体、轴突和树突形成三突触结构。在生理和病理情况下,星形胶质细胞对突触的形成、成熟、维持以及突触可塑性的调节有重要作用。突触可塑性是认知和学习记忆的基础。阐明星形胶质细胞对突触可塑性的调节机制,可为我们进一步认识大脑功能以及中枢神经系统疾病的治疗提供新的思路。因此,本文将对星形胶质细胞在生理和病理情况下对突触可塑性的研究进展进行综述。     

神经营养因子和生长因子在神经干细胞中的研究进展

神经营养因子(neurotrophic factors,NF)包括神经生长因子(nerve growth factor,NGF)、脑源性神经营养因子(brain-derived neural neurotrophic factor,BDNF)等。生长因子(growth factors,GF)家族成员有酸性成纤维细胞生长因子(acidic fibroblast growth factor,a FGF)、碱性成纤维细胞生长因子(basic fibroblast growth factor,b FGF)、血管内皮生长因子(vascular endothelial growth factor,VEGF)等,两大家族均对神经系统的发育以及维持神经干细胞(neural stem cells,NSCs)的存活、促进其增殖、分化并诱导其定向迁移等众多方面发挥着重要作用。本文简要概括介绍NF中的重要成员之一脑源性神经营养因子,GF家族中的重要成员VEGF和b FGF对NSCs的影响。     

Practical research-based guidance for motor imagery practice in neurorehabilitation

Purpose: The purpose of this appraisal is to offer guidance to clinicians on applying motor imagery in neurorehabilitation and provide guidance to support this process.

Method: We used evidence from a variety of fields as well as clinical experience with motor imagery to develop guidance for employing motor imagery during neurorehabilitation.

Results: Motor imagery is a relatively new intervention for neurorehabilitation supported by evidence from areas such as cognitive neuroscience and sports psychology. Motor imagery has become a very popular intervention modality for clinicians but there is insufficient information available on how to administer it in clinical practice and make deliberate decisions during its application.

Conclusions: We provide evidence-based guidance for employing motor imagery in neurorehabilitation and use the principles of motor learning as the framework for clinical application.

Implications for Rehabilitation

• Motor imagery has become a very popular technique for clinicians in neurorehabilitation; however, research reports provide insufficient information for clinicians to employ motor imagery in the clinic.

• The principles of motor learning can be used as a useful framework for employing motor imagery in neurorehabilitation.

• We provide clear guidance to deliver individual-tailored motor imagery in neurorehabilitation based on evidence.

     

Elizabeth Usher Memorial Lecture: Lost in Translation? Challenges and future prospects for a neurobiological approach to aphasia rehabilitation

Abstract

While there has been considerable progress in conducting trials of aphasia therapy, there is no consistent evidence for long-term benefits of aphasia treatment, suggesting the need to reconsider current approaches. There are also no accurate methods for determining the amount, type and timing of aphasia therapy that should be provided for an individual. At the same time, there has been increasing interest in applying various principles of neuroplasticity to aphasia treatment and using measures of brain structure and function to predict recovery. This article will consider the potential of neuroplasticity principles and neurobiological predictors to improve our current approach to aphasia rehabilitation and optimise outcomes. Reviewing these principles highlights some of the challenges of translating animal model-based principles and emphases the need to also consider relevant theories of human learning. While considerable progress has been made in considering neurobiological principles and using measures of brain structure and function to predict recovery, there is significant work required to achieve the full potential of this neurobiological approach to aphasia management.     

改性聚乙二醇水凝胶封装生长因子和内皮祖细胞及其可控性缓释

背景：大量研究表明,为了实现聚合物材料的内皮细胞化,向材料表面负载生物活性因子是一种重要的手段,并且在聚合物材料表面引入人体血管内皮细胞将有助于提高材料的生物相容性。 目的：合成封装碱性成纤维细胞生长因子、血管内皮生长因子和内皮祖细胞的水凝胶,观察生长因子的缓释效果,以及内皮祖细胞在水凝胶中的培养状态。 方法：合成含精氨酸-甘氨酸-天冬氨酸肽段的聚乙二醇水凝胶,先后加入大鼠内皮祖细胞、碱性成纤维细胞生长因子、血管内皮生长因子溶液、基质金属蛋白酶反应底物肽段溶液。将上述水凝胶浸泡于PBS中,每12h用ELISA法检测上清液中生长因子的水平;72h后在水凝胶PBS溶液中再分别加入不同质量的基质金属蛋白酶2（100,1000ng）、基质金属蛋白酶9（100,1000ng）,每12h用ELISA法检测上清液中生长因子的水平。将封装内皮祖细胞的聚乙二醇水凝胶置于培养基中培养5d,消化后用流式细胞仪检测存活细胞数。 结果与结论：12—72h内,碱性成纤维细胞生长因子、血管内皮生长因子的释放百分比一直维持在41％左右,72h后分别加入不同质量的基质金属蛋白酶2、基质金属蛋白酶9,发现两种细胞因子的释放百分比呈稳步上升,72h后已达95％以上,且基质金属蛋白酶质量越大两种因子的检测释放百分比越高。培养5d后,在聚乙二醇水凝胶中仍有88．17％的内皮祖细胞存活。表明白组装聚乙二醇水凝胶既可以实现碱性成纤维细胞生长因子、血管内皮生长因子的可控性释放,又可以支持内皮祖细胞的增殖生长。     

血管生长相关因子在脑血管畸形中的差异性表达

背景：脑血管畸形是在青壮年人群中造成出血性脑卒中的常见病因,畸形血管破裂出血可引发严重的神经功能障碍。脑血管畸形的形成及发病原理尚不明确。现代分子生物学的研究表明血管生长相关因子在脑血管畸形中可能存在异常表达。目的：评价血管生长相关因子在脑畸形血管中的表达差异,探讨血管生长相关因子与脑畸形血管形成的关系。方法：选择脑血管畸形患者与颅内出血开颅治疗患者各50例,通过免疫组织化学染色方法检测脑血管畸形标本和开颅治疗患者颞浅动脉标本中血管因子的表达差异。结果与结论：正常颞浅动脉中血管生长相关因子（血管内皮生长因子和转化生长因子α）几乎不表达,畸形血管中两者高表达（P〈0.05）。结果证实,与正常血管相比,脑血管畸形患者血管内皮生长因子和转化生长因子α的表达存在明显差异,脑畸形血管患者血管组织可表达更多的血管内皮生长因子和转化生长因子α。     

Increasing collaboration within a multidisciplinary neurorehabilitation team: the early stages of a small action research project

? This paper describes how the process of action research is being used in undertaking a team-focused, practice-based project. ? The problems that the team has previously experienced in initiating change are outlined. ? An explanation is advanced as to why action research is an appropriate strategy for the team to adopt, and the early stages of the action research project are described. ? This is followed by a discussion of how the outcome of such research can be generalizable from one clinical setting to another.     

Perspectives and challenges in regenerative medicine using plasma rich in growth factors

Plasma rich in growth factors (PRGF-Endoret) is an endogenous therapeutic technology that is gaining interest in regenerative medicine due to its potential to stimulate and accelerate tissue healing and bone regeneration. This autologous biotechnology is designed for the in situ delivery of multiple cellular modulators and the formation of a fibrin scaffold, thereby providing different formulations that can be widely used in numerous medical and scientific fields including dentistry, oral implantology, orthopedics, ulcer treatment and tissue engineering among others. Here we discuss the important progress that has been accomplished in this field. Furthermore, a comprehensive outlook of the intriguing therapeutic applications of this technology is presented.     

胎儿生长受限的相关因素及预防

目的探讨胎儿生长受限（FGR）的相关因素及预防措施。方法回顾性分析我院妇产科2004年9月至2009年12月106例胎儿生长受限的临床资料,针对各类病因制定相应的预防措施。结果孕妇不良的生活习惯、有害的环境因素、脐带因素、妊娠合并症、遗传因素等可导致胎儿生长受限的发生。结论加强孕期保健,定期产前检查,避免有害的环境因素,积极治疗妊娠合并症是减少FGR的发生,改善围生儿预后的重要措施。     

Overview of the role of hematopoietic growth factors in bone marrow transplant recovery and bone marrow transplant failure

Morbidity of bone marrow transplantation has been reduced by the prophylactic use of myeloid stimulating growth factors. Trials are current exploring the usage of hematopoietic growth factors in a variety of other potential clinical applications in bone marrow transplantations. These include stimulation of multipotent progenitor cells, enhancement of monocyte macrophage function, enhancement of lymphocyte function, and alteration of inflammatory mediators which are causal of nonhematologic toxicities of bone marrow transplantation. Hematopoietic growth factors, factors which induce production of stimulatory cytokines and/or factors which alter inflammatory pathways, may be effective in improving the tolerability of patients undergoing bone marrow transplant.Presented as an invited lecture at the 6th International Symposium: Supportive Care in Cancer, New Orleans, La., USA, 2–5 March 1994     

Vascular endothelial growth factors in retinal and choroidal neovascular diseases

Abstract

Angiogenesis, or neovascularization, refers to development of new vessels from pre-existing vasculature. Retinal and choroidal neovascularization leads to oedema, haemorrhages, and fibrosis, causing visual impairment and blindness. In multiple studies, vascular endothelial growth factor (VEGF) has been shown to be the most important factor in ocular angiogenesis. Recently discovered anti-VEGF treatments have revolutionized the therapy of neovascular diseases in the eye. These agents have been shown not just to stop the angiogenic process and maintain visual acuity but also improve vision in a great proportion of patients at least during a 2-year follow-up. However, there are also problems with these agents and their delivery regimens, and new therapeutic strategies are needed. This review summarizes the most important growth factors participating in the angiogenic process in the retina and the choroid, diseases where angiogenesis plays the most devastating part causing visual impairment, as well as current antiangiogenic treatments for these diseases.